405 IAC 5-16-6 Freestanding clinics and surgical centers; limitations

Sec. 6. Medicaid reimbursement is available to freestanding clinics and surgical centers for services provided to members subject to the following limitations: (1) Prior authorization is required for all services and supplies the charges for which exceed the cost limits or utilization parameters set out in this article. (2) Medicaid reimbursement is not available for facility charges if the services provided are such that they ordinarily could have been provided in a physician's office. Such services provided outside a physician's office will be reimbursed at the fee allowed for the same service provided in the office.